Provider Demographics
NPI:1124296454
Name:PATEL, BHAVNA J (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:BHAVNA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2462
Mailing Address - Country:US
Mailing Address - Phone:517-796-9488
Mailing Address - Fax:
Practice Address - Street 1:205 PAGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2462
Practice Address - Country:US
Practice Address - Phone:517-796-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI146521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice